Twice unmatched

[Drudog]

Hey guys,

I thought i would post my situation and see if anyone has some valuable opinions or personal stories on this. I just went unmatched in ortho for the second time. First time around I had only 8 interviews but this time around I had 15 interviews. My boards are 243 and 248 with mostly high passes in my 3rd and 4th year except for ortho rotations in which i got honors. Last year I had no publications so I did a pretty productive research year this year. On my app this year was a bunch of submitted but still under review studies. By next years application i should have 2 JBJS articles and 2 published textbook chapters, all ortho. I recently scrambled into a surgical prelim spot. I sought feedback on my application and interview from both my home institution and the institution where I did research this past year. Basically they all explain that its very competative and I have a couple downsides that I cannot change. These are that I did my 1st year at a Caribbean med school before transferring to an american school, I am not AOA, and I dont have all honors. All of them said that my interview went "very well".

Basically I am looking for any advice anyone has on where to proceed from here. Am I dead in the water for ortho? If not, how can I approach my next year smartly to make the 3rd time a charm? What additional letters of rec should I seek? Is it beneficial to get them from attendings (gensurg even?) that I work with that proclaim me to be a good intern? I am obviously planning on working my butt off all year as well as getting an ortho rotation at my new hospital at some point before invites go out. Any advice would be helpful, really. I am 26 years old and am willing to do what it takes to match, but if it wasn't meant to be, I don't want to keep butting my head against a brick wall. Thanks ahead of time for any responders.

[netminder]

I will preface my comments with the statement that I have not yet applied, so take this with a grain of salt. Just from talking to people about the application process, it seems like contacts with people who would be willing to make phone calls on your behalf are extremely valuable. Do you have anyone like this in your corner? It seems strange that someone with >240's who does well on interviews, has pending JBJS pubs, has honored ortho, etc. would not match -- twice. I know this is wicked competitive, but is it possible that one of your LOR's may be a detractor? Is there any way you can "press," gently, a little harder at the places you interviewed for some more information on how you can improve your application?

Maybe ask, "Should I consider eliminating any of my current letters of recommendation?" This is a bit forward, but you would hate to be the victim of the same fate a third time. Good luck.

[Drudog]

yea I am lucky enough to have a couple people like that in my corner. I think a mistake I had this year was not be too aggressive in asking them to preemptively call places this year. The letters I got from them I was told are superb so I am at least going to keep those 2. I am thinking of trying to get one from an attending next year where I am going to work to add to it. Thats my current plan at least. Thanks for the feedback.

[jdoc]

That’s difficult to understand and a bit frustrating to hear. I didn’t go to a Caribbean school, but I have met program directors who are convinced that taints an applicant in a way that is irreparable (which is completely unfounded and stupid). It would seem, however, that should have taken a back seat to the fact that you only did one year there and did your clinical years at a US school and graduated US. AOA is very helpful, but less than 30% of the folks who match each year are AOA. Honors are important, but there too people match all the time with only a few honors (and you got yours in ortho). Your Step one and two really should speak to the fact that you know your stuff and have the intellectual ability to learn ortho.
I wonder about the mix of places you applied to and interviewed at. Did you include a good geography, community and academic programs, not all “top teir programs”?
I would gun for the program you’re doing your prelim at. Go to conferences, offer to present articles at journal clubs, get to know the residents, work your tail off on your ortho rotation, maybe do some research with one of the attendings (always nice to have an experienced researcher on board). Ask the PD what you need to do to get in and show him/her you’re willing to do it.
I used to be more conservative about how likely someone in your situation is to get in to ortho after all. However, after having a good friend take a spot at a program outside the match after going unmatched three years in a row I’ve changed my tune a little. By the way, he did all four years Caribbean and did not have your scores at all. Having people in your corner making phone calls and pushing for you is a big deal. Find that person (those people) early this year. In the end you have to decide when to hang it up. Pray (if you’re the praying type), talk with those close to you who know you well, and decide if it’s worth it to give it another go or if you should find something you could be happy with outside ortho. Good luck.

[Drudog]

What point is it helpful for people to make calls? Before I apply? after I apply and before interviews? After interviews?

Thanks for the advice guys. I appreciate it.

[netminder]

What point is it helpful for people to make calls? Before I apply? after I apply and before interviews? After interviews?

Because I have not gone through this process yet, I will defer to those who have. But for what it's worth, based on my conversations with people in positions to select us, it sounds like phone calls received between the time when you submit your application via ERAS and when interviews are offered (perhaps right around the submission deadlines) would be of most help. This way, you could potentially maximize the number of interview opportunities, and also potentially make your application stand out from the others. If these people are truly your advocates, the interviewers will be able to put your face with the name they will have heard from someone influential.

Good luck, man. Don't quit on this. Press on if you really want this; it sounds like you do. Do everything you can do to find out what you need to change about your application and then change it. Your stats are excellent.

I hope this works. Validate with those in the know. I am not one of them, but I am happy to share what I have heard.

[Basupra]

I too transferred from the Caribbean to an LCME school and am happy with the results from the match, though I will say that I encountered quite a bit of stigma. Prior to applying or residency, I spoke to someone who had also transferred and matched into ortho. He told me that having the Caribbean had a very negative effect on his application and he did not match close to where he wanted despite superior board scores, publications, etc..

Having gone through the application process, I too can say that having the Caribbean on your application is definitely tainting. So a little about my application, ~250 Step 1, AOA, many honors, great letters (got to read them at an interview), amazing narratives from an away, 'best medical student in years mentioned several times in my application, etc.. When on the trail, >50% of the time during each interview was spent having me explain why I went to the Caribbean, why I didn't get into an LCME school, etc.. Some were like 'your MCAT must have been horrendous'. It wasn't.

One interviewer said the following:
basupra, you are a great candidate and you have proven your ability to do well in medical school, but so did the guy I just interviewed. Why would I take my chance with you when the guy before you has a proven track record?

Another interviewer was in utter disbelief that I was offered an interview at his institution after finding out I transferred.



It is unfortunate, but ortho really is extremely competitive and there are some phenomenal candidates. They can pick and choose.

[Drudog]

I understand the stigma but I guess my question is if there is anything I can do about it or am I hosed? I guess all I can do is focus on my correctable deficiencies and pray but I just wanna know if I am wasting my time or not. Basically my thought process is this: While I cannot change things like my grades or my Caribbean 1st year, i can correct what they say about me by working my tail off during my prelim and letting them know whatever deficiencies i had that led to me not getting into an LCME school to begin with are irrelevant to my potential as a resident. Is this a pipe dream? TO ME (and obviously I am biased) someone who climbed up from the carribean, did a research year and nailed his intern year would be the more proven applicant.

Also does anyone have any input on this: I worked with a lot of fellows on research this year and have formed some good relationships with them. Would these guys/girls be beneficial on my advocate list for calling programs or am I better off just sticking with the attendings i worked with?

once again thanks everyone for your input!

[netminder]

Also does anyone have any input on this: I worked with a lot of fellows on research this year and have formed some good relationships with them. Would these guys/girls be beneficial on my advocate list for calling programs or am I better off just sticking with the attendings i worked with?

I've had lots of people tell me that big names go a long way in this process.

[billm]

The fellows could put in a call to their former program and that could help. I know my program will interview people who were recommended by former grads and a few of those have matched, when otherwise they might not have been interviewed. good luck

[KneeMD]

I think you are doing well in getting a clinical internship under your belt...I hope you are able to satisfy all ACGME ortho requirements so you could jump on a PGY-2 ortho spot when available. Try to frontload your ortho rotations so you can get fresh letters, and obviously do nothing but your very best, always.

Eventually, people will have to realize that you're not a project, or a prospect, but a proven commodity. Weighing non-ortho intangibles (MCAT, first year, Step 1 scores) over ortho measurables (research/pubs/PGY-1 rotation evals) reflects poorly on the program rather than you, the applicant. If any of your prior "felonies" come up in an interview, just remember that you got invited for a reason and give a conclusive answer in a cordial manner. Be a good interview, have a story to tell. It's likely an interrogation tactic to test your reaction to adversity.

Long story long, no you're not dead in the water. Pursue your dreams and remember that ortho is a life-long journey, not a destination. Best wishes!

[billIam]

Dru... I'm pretty sure I interviewed with you at a few places - and I know you're a decent guy, so I'm sorry to hear that you didn't match this time around.

That being said - I know 2 guys who are straight up FMGs that matched this year, so I know it can be done. One of them did research for like 4 years and one did some ortho-related work for a while. They both matched at the program that they were working at. The above posts are dead on - your best chance is at the program that you're doing your prelim at. They know you, they can see you everyday (not just for 15 mins in an interview), and they can make a much more accurate assessment of what you can bring to the table. Just like the guy above said - go to all of the journal clubs, all of the conferences you can, offer up your skills as a researcher, and lay it all on the line. Having met you, I'm confident you'll land a spot if you put the sufficient amount of effort forth.

Good luck man...

[Drudog]

Thanks for the kind words and the advice. I'll try and knock it out of the park next year!

[ors]

Do not get caught up in all the details.

I had a friend who applied 3 times with a similar situation and got a great residency.

Between each time he improved his chances by:

1. Research
2. Doing a general surgery prelim year and rockin' it
3. Getting better LORs from people he worked with.

Each year he increased the number of programs he applied to and the number he interviewed at.

He graduated last year and is very happy.

Good luck.